| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $118.72 | $560.15 | $743.26 | |
Moda Health
| Professional | $558.04 | $558.04 | $558.04 | |
Pacific Source
| Facility | $347.40 | $458.25 | $540.60 | |
Providence
| Facility | $118.72 | $560.15 | $743.26 | |
Providence
| Professional | $558.04 | $558.04 | $558.04 |